Healthcare Provider Details

I. General information

NPI: 1518566959
Provider Name (Legal Business Name): TEMITOPE HASSAN57 OKUNEYE HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 MITCHELLVILLE RD
BOWIE MD
20716-1577
US

IV. Provider business mailing address

2376 MITCHELLVILLE RD
BOWIE MD
20716-1577
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-8104
  • Fax:
Mailing address:
  • Phone: 240-413-8104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: